Case series of completed suicides by burning over a 13-year period

Suicide by burning is an extreme act that is uncommon in the United States and throughout the Western world. The characteristics of people who complete such acts are not well understood. To address this issue, we examined the death records of the King County Medical Examiner's Office in Washington State over the 13 years from 1996 to 2009. Twenty-five cases of suicide by burning were identified and used to characterize decedent demographics, circumstances of death, and motivating factors. Compared to other methods of suicide, burning demonstrated a significant overrepresentation of decedents who were women, 40-59 years of age, and Asian/Pacific Islander. They also tended to have previous psychiatric illness and/or substance abuse issues. Self-burning predominantly occurred at the decedent's residence with the intent of suicide given. There was no unifying theme in motivating factors. Together, these data represent the characteristics of people whose death is because of suicide by burning in King County, Washington.     

Profile of Hospital Admissions due to Self‐Inflicted Harm in Los Angeles County from 2001 to 2010

We aimed to describe the demographic profile of self‐inflicted harm (SIH) in Los Angeles County between 2001 and 2010 and to investigate trends over this 10‐year period. We used the California Hospital Discharge Data to investigate all cases of hospital admission due to SIH, including suicide attempts and if they had a concurrent psychiatric diagnosis based on ICD‐9 codes. African‐Americans (AA) had the highest 10‐year SIH admission rates. SIH admission rates remained steady throughout the 10‐year study period. Median age of SIH was significantly lower in Latinos. Episodic mood disorders were the most common psychiatric comorbidity. The use of solid/liquid poisoning was the most common SIH method among all racial/ethnic groups. We found major disparities in SIH admissions across racial/ethnic subgroups. The importance of programs to identify, prevent, and treat SIH in these groups is discussed.     

Self‐Strangulation Through A Sphygmomanometer: An Uncommon Suicide

Suicide by asphyxia is quite a common event in forensic practice and may be implemented in different ways. The authors report a unique case of a 16‐year‐old youth who committed suicide by means of a standard mercury sphygmomanometer. This manner of suicide has never been described in the literature reviewed. A complete forensic investigation led to the conclusion that the cause of death was mechanical asphyxia, ascribed to self‐strangulation by means of an atypical item. The victim suffered from attention‐deficit/hyperactivity disorder (ADHD) syndrome and was assisted by support teachers. He had a solitary and depressive personality. The exceptional nature of this case suggests that sphygmomanometers may be regarded as possible means of self‐strangulation. The case also highlights the importance of managing patients with psychiatric or cognitive disorders; indeed, particular caution is required to keep them away from objects that, although apparently harmless, can become lethal.     

比较法视野下的司法鉴定制度的反思

司法鉴定是依据科学的基础原理由专业的鉴定人员做出结论的实证技术活动。它是科学的产物,但是不一定等于科学。如果不能对错误司法鉴定进行区分、鉴别的话,其结果只能是一个盲人领着一群盲人。司法鉴定制度有其独特的运行规律,也有其异域的可以借鉴之处,这些也是保证司法鉴定科学、合法、准确必须抓住的要素。     

Suicide Pacts: Six Cases and Literature Review

A suicide pact is the decision of two or more people to die together. This event is rare. The majority of suicide pacts victims are married, socially isolated, with a serious physical illness in one or both partners. We performed a retrospective study of all cases of suicide pacts leading to death between January 1, 2003 and December 31, 2010 referred to the Forensic Medicine Department of Tours (France). Six cases were recorded as suicide pacts. Firearms were the preferred means of death. Five suicide notes were discovered. For some cases, it was difficult to establish whether death was the result of a suicide pact or of a homicide–suicide without the consent of the victim. An objective element, such as a suicide note and motive, is required to prove that a suicide pact is involved. The prevalence of mental disorders is hard to assess. In France, psychological autopsies are not performed in such cases, as the investigation is usually very sparse after the death of both individuals.     

Planned and unplanned complex suicides: a 5-year retrospective study

The notion of planned and unplanned complex suicides first appeared in 1974 by Marcinkowski and, since then, no systematic study of complex suicides has been published in the English forensic literature. Here, the authors present a 5-year retrospective study of complex suicides. Nineteen complex suicides were reviewed: five unplanned and 14 planned, including the first case of an unplanned complex suicide in a woman. All cases were analyzed in terms of gender, age, methods of suicide, the presence of a suicide note, and past suicide attempts, and statistically compared with a 50-case sample of simple suicides. A further comparison was established with compiled data from the literature. Similarities were revealed regarding incidence of complex suicides, male gender predominance, and types of methods used. In contrast, results showed a higher average age for planned complex suicide victims. Finally, the authors discuss the application of the complex suicide definition.     

Suicidal decapitation using a tractor loader: a case report and review of the literature

In forensic practice, decapitated bodies are predominantly associated with decapitation by wheels of trains or with postmortem dismemberment following homicide. In the suicidal context, decapitation accounts for less than 1% of total suicide. Apart from decapitation by trains, other encountered methods involve suicidal hanging and vehicle-assisted ligature suicide. Reported here is a unique case of suicidal decapitation in a 45-year-old man using a tractor loader at the foot of a silo, on his farm. The head was recovered in the loader and there were several impact spots from the loader as well as blood on the silo wall. The autopsy revealed a complete decapitation wound with the severance plane located between the third and fourth cervical vertebra. A 1.5 cm wide abrasion on the anterior part of the neck and abrasions under the chin were noted. This very unique case of intentional suicidal decapitation is the first reported case of a planned system intended to create decapitation outside the unique case of homemade guillotine and the more common decapitation by train.     

Different Mechanisms of Decapitation: Three Classic and One Unique Case History

Abstract: Three classic cases and one exceptional case are reported. The unique case of decapitation took place in a traffic accident, while the others were seen after homicide, vehicle‐assisted suicide, and after long‐jump hanging. Thorough scene examinations were performed, and photographs from the scene were available in all cases. Through the autopsy of each case, the mechanism for the decapitation in each case was revealed. The severance lines were through the neck and the cervical vertebral column, except for in the motor vehicle accident case, where the base of skull was fractured. This case was also unusual as the mechanism was blunt force. In the homicide case, the mechanism was the use of a knife combined with a saw, while in the two last cases, a ligature made the cut through the neck. The different mechanisms in these decapitations are suggested.     

An Autopsy Case in Which Self‐Bloodletting Via a Cervical Blood Access Led to a Fatal Outcome*

Abstract: A 48‐year‐old woman was found dead on a chair in her living room. She had received dialysis every day because of chronic renal failure for the past 15 years. On a table beside her, there was a mirror and 10‐mL syringe on a napkin. A stopper was out of place in a portion of a three‐way blood access tube established in the right cervical region, and blood coagulation was noted in the lumen. There was a bloodstained measuring cup on the floor. Autopsy findings included a large number of shunt traces in the bilateral infraclavicular fossae and upper limbs, as well as the cervical blood access terminal reaching the right atrium via the internal jugular vein to superior vena cava. Various organs showed anemia. Neither a fatal lesion nor injury was noted in the main organs. Therefore, this patient may have committed suicide by self‐bloodletting via a cervical blood access.     

Police officers who commit suicide by cop: a clinical study with analysis

Suicide by cop has become a familiar topic among members of law enforcement, mental health professionals, and the general public. This paper presents two cases where police officers chose to commit suicide by getting other police officers to kill them. The two police officers studied, by examination of closed case files, were found to be similar to civilians who committed suicide by cop on several demographic (gender, age, history of mental illness, and suicide attempts), and situational (stress factors, trigger) variables. The cases help us to understand possible motives and management for individuals who choose to end their life in this manner.     

Schizophrenia and suicide: a 10-year review of Kentucky medical examiner cases

The risk of suicide is significantly increased in schizophrenics; it is estimated that 10-13% of individuals suffering from schizophrenia commit suicide. Schizophrenia is marked by psychotic exacerbations and remissions, with persistent deterioration in baseline functioning with each relapse. We present a 10-year (1993-2002) retrospective review of Medical Examiners' cases of suicide of schizophrenic victims. Twenty-nine cases were between the ages of 20 and 75 (mean age of 41.6 years). The majority of victims were male (62.1%) and Caucasian (86.2%). The leading method of suicide for both males and females was firearm injury (48.3%) mostly of the head, followed by overdose (20.7%), and hanging (13.8%). A comprehensive investigation of the biopsychosocial factors is warranted in cases of schizophrenics who commit suicide. This study offers an insightful analysis pertaining to the determination of intent in formulating the manner of death in this unique population.     

Shark‐Inflicted Trauma: A Case Study of Unidentified Remains Recovered from the Gulf of Mexico*

Abstract: Here, we present a case of an unidentified male whose remains, except for the right arm, were recovered from the Gulf of Mexico 10 years prior to osteological analysis by forensic anthropologists. After the poorly preserved soft tissue was removed and the bones cleaned, forensic analysis revealed an unusual series of hard tissue trauma later attributed by a shark expert as shark scavenging and/or predation. Identified were five unique hard tissue trauma patterns that are bite mark artifacts produced by sharks: punctures without fractures, punctures with associated fractures, striations with bone shaving, overlapping striations, and incised bone gouges. The cooperation among experts provided a comprehensive death case analysis and a better understanding of shark‐inflicted trauma on human skeletal remains.     

Self‐Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review

Self‐embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty‐two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two‐thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.     

Self‐harm Risk Among Adolescents and the Phenomenon of the “Blue Whale Challenge”: Case Series and Review of the Literature

The “Blue Whale Challenge” is a dangerous Internet phenomenon. As per media reports, it involves a series of life‐threatening tasks imposed by a “curator” to “players,” who must fulfill the whole list, and it ends with the suicide of the player. The authors report the data of five suspected cases of “Blue Whales” managed from January 2016 to December 2017 by the staff of a unit (the “Bambi Unit” of the Pediatric Hospital “Regina Margherita” of Turin, Italy) that is dedicated to the evaluation of suspected abused children. Then, they analyzed this data in the light of the literature regarding self‐harm. This comparison highlights the role of the Internet in the spreading of self‐harm behavior among vulnerable adolescents who are characterized by epidemiological, psychological, psychiatric, social, and cultural risk factors. In conclusion, the authors suggest a multidisciplinary and specialized approach in the evaluation of adolescents who committed self‐harm activities.     

A distant-range, suicidal shotgun wound of the back

The case being reported is one of a shotgun fatality with a thoracic back wound. A 23-year-old man was shot from a distance with trajectories going from back to front and on a nearly horizontal level. These findings observed in the autopsy could represent homicide, but scene investigation and police records were interpreted and it became clear that the case was suicide. Thus, this case shows that the determination of the manner of death requires a careful forensic investigation including autopsy findings, scene investigation, and reconstruction of the events.     

Planned Complex Occupation‐related Suicide by Captive‐bolt Gunshot and Hanging*

Abstract: Planned complex suicides are committed by using two or more previously planned methods simultaneously to make sure that death will occur even if one method fails. Herein, we presented a case of occupation‐related planned complex suicide, committed by captive‐bolt gunshot and hanging. A 29‐year‐old man, who worked as a butcher, was found dead in the stable, hanging by the neck with a captive‐bolt gun embedded in the forehead region of his head. The hanging was complete. Along the bolt canal were bone fragments, and at the end of the path was the punched‐out fragment of the skin and soft tissue. There were no fractures of the hyoid bone and laryngeal cartilages, and a superficial hemorrhage was present in the right sternocleidomastoid muscle. Our case underlines the utility of forensic autopsy and death scene investigation in reconstructing the mechanism of death, as well as the dynamics of the event.     

Suicide by cop among female subjects in officer-involved shooting cases

An analysis of suicide by cop (SBC) among female subjects in a large sample (n = 707) of officer-involved shootings (OIS) is reported. Women represented 3% of the total sample (n = 21) and 5% (n = 12) of the 256 SBC cases. Therefore, 57% of the women (n = 12) were classified as SBC, and 81% of the women (n = 17) behaviorally evidenced some suicidal motivation. The results underscore that when a female subject becomes involved in a situation leading to an OIS, there is a very high likelihood that she is motivated to be intentionally killed. She is almost guaranteed to have a diagnosed mental disorder, has been prescribed psychiatric medications, and is abusing a substance at the time, most likely alcohol. Nevertheless, she also poses a serious risk of injury to both police officers and civilians during the encounter and will possess a firearm half the time. The wish for suicide is often precipitated by serious relationship issues. Comparisons are made to the male subjects in our previous study.     

A Long‐term Study of the Association between the Relative Poverty Rate and Suicide Rate in Japan

The annual number of suicides in Japan totaled around 23,000 in 1997 and abruptly increased to around 31,000 in 1998. This figure has remained high since then. This abrupt increase in the number of suicides was primarily due to an increase in suicides occasioned by economic concerns. The association between various economic factors and suicide must be studied in detail and over the long term in order to ascertain the association between economic concerns and suicide. This study examined the relative poverty rate and the suicide rate in Japan over 30 years and discussed the association between those two rates. The results suggest that the relative poverty rate may be associated with the suicide rate for both sexes. This association is true for men in particular. The organizations and professionals involved in implementing suicide prevention measures should be cognizant of the current findings and consider formulating additional specific measures.